Silva Neves Specialist Psychotherapy in Central London W1 & EC1



Individual Therapy. Romance

Individual Therapy

The most common male sexual problems are:
  • Erectile dysfunction: when it is difficult to develop or maintain an erection during sexual activity.
  • Premature ejaculation: when unwanted ejaculation occurs before penetration or soon after penetration.
  • Delayed ejaculation: when ejaculation is wanted but does not occur after a prolonged time of sexual activity.
  • Male anorgasmia: when wanted orgasm does not occur. This may be linked to delayed ejaculation.
  • Loss of sexual desire: when there is no desire to be sexual with a partner or self.


  • The most common female sexual problems are:
  • Vaginismus: when penetration is not possible.
  • Dyspareunia: when penetration is painful.
  • Female anorgasmia: when orgasms do not occur.
  • Loss of sexual desire: when there is no desire to be sexual with a partner or with self.


  • 'Courage is simply the willingness to be afraid and act anyway' Dr Robert Anthony



    Individual Therapy. fatmirror

    Body Image

    In our modern age of selfies, Instagram and dating apps, many men and women struggle with their body image. People might become highly preoccupied with going to the gym excessively or starting extreme diets.

    Feeling bad about your body contribute to sexual problems.

    You may have a problem with your body image if:
  • Frequent preoccupation with body image and body shape to the extent of controlling your life.
  • Feeling distressed, unhappy or depressed when you look at your body.
  • Excessive exercise.
  • Always on a diet, juicing, detoxing, etc.
  • Problems with relationships: avoiding social occasions because you think you look bad.

    You may have body image distress if you feel bad about your appearance:
  • At social gathering where you know a few people
  • When you look at yourself in the mirror
  • When you are with attractive people
  • When someone looks at parts of your appearance that you dislike
  • When you try on new clothes
  • When you exercise
  • After you have eaten a full meal
  • When you wear revealing clothes
  • When you get on the scale to weigh
  • When you think someone has rejected you
  • When in a sexual situation
  • When you are in a bad mood
  • When you think of how you looked when you were younger
  • When you see yourself in a photo or on video
  • When you think you have gained weight
  • When you think about what you wished you looked like
  • When you recall hurtful things people have said about your appearance
  • When you are with people who talk about weight or dieting

    Problem with your body image can cause serious difficulties with starting, maintaining or managing a romantic and sexual relationship. It may also be difficult to maintain good friendships. If you feel preoccupied often by the way you look, do not hesitate to make an appointment to discuss it.



  • Individual Therapy. sex not working

    My article on sexual problems

    When Sex Doesn't Work
    A lot of people think that having sex should be easy and should happen without even thinking about it. Therefore, when sex doesn’t work, it leaves people feeling ashamed and broken: ‘why can’t I do this normal and natural thing that everyone else seems to be able to do?’

    Our sexuality lies at the core of our being. We are born with it and we develop it from the moment we are born. This means that sexuality is complex and, therefore, having sex is a complicated act.

    When one has sex, it is not merely the exploration and union of two bodies. We bring in bed with us our morals, our judgements, our core beliefs about ourselves, our beliefs about being a man or a woman, what it means to us to be sexual in some particular contexts, our fears and hopes, and what we believe about the partner(s) we are having sex with.
    Growing up, we constantly receive messages about sex, and, as children, we have to make sense of those messages.

    Consider the following scenario: a boy grows up in a home where sex is never talked about. When there is a sex scene in a movie on television, he witnesses his parents hurrying to the remote control to change the channel. The message that the boy will understand from this is ‘sex is wrong’, ‘sex is shameful’, ‘parents do not approve of sex’. Then this boy ends up in a changing room at the end of PE and is teased by his peers because he has a ‘small penis’. This increases his shame and a feeling of inadequacy towards his peers. In time, the boy develops and goes through puberty. He finds himself with a sexual partner for the first time. He feels extremely anxious because it is his first sexual encounter, and his partner is likely to also feel extremely anxious. Because of the anxiety, he doesn’t manage to get an erection. This event is especially devastating for a man, because it makes him question his sense of masculinity and results in tremendous shame. The second time he attempts to have sex, he will feel twice as anxious as the first time and the likelihood is that he will not have or maintain an erection then either because of the compounded anxiety and shame.

    Now, let’s look at this scenario: a girl grows up in a family with parents shouting at each other all the time. She learns the message ‘relationships are bad or painful’. Then, at school, she is teased by her peers for being overweight. This is deeply shameful. The girl grows up and becomes a teenager. Her body changes massively in a short space of time. Her parents are too busy arguing with each other to notice the changes, and nobody talks to her about becoming a woman. Going through this process of change with no support or information can be very shameful and painful for a young teenage girl. She will ask herself some questions about her body: ‘Am I fat?’ ‘are my breasts too big?’ ‘how do I manage my periods?’, and so on. When she finds herself with her first sexual partner, she is full of anxiety. Because of the anxiety she finds penetration very painful. She dissociates and tells herself that the first time is always painful but she feels a lot of pain the second time and the third time too. This results in tremendous shame because she feels she has let her sexual partner down. She feels she might be ‘frigid’ or ‘less than a woman’. This increases the likelihood that each time she is in a sexual situation she will fear the anticipation of pain so much that anxiety and shame will continue to increase.

    These, of course, are only simple examples; there are very many other experiences that may contribute to sexual difficulties. The main issue I would like to stress is that when sex doesn’t work it is because most people find it difficult to talk about it. In turn, the less it is talked about, the more there will be shame around the issue.
    It is often not possible to talk about sex with parents, teachers, peers and even some therapists.

    If you experience a sexual problem, it is important to consider the following:
    Firstly, is my sexual problem due to physical factors? It is very common that sexual dysfunction is linked to a physical cause. For example, erectile functions can be affected by a heart condition, diabetes, some medications, low levels of testosterone, and so on.
    Painful vaginal intercourse (dyspareunia or vulvodynia) can be caused by hormonal contraception, an allergic reaction, some medications, yeast infection, pelvic floor dysfunction, and so on.

    I would recommend that if you suffer from any sexual problems that you ask your GP to carry out the necessary tests to find out if there is a physical problem.
    If there are no physical causes found, you can safely assume that your sexual dysfunction is of psychosexual cause.

    Your second step is to look for a therapist. As mentioned above, some therapists are not comfortable talking about sex. It is therefore important that you look for a therapist that is specifically trained in psychosexual issues.

    Psychosexual therapy (also called sex therapy) combines a behavioural approach (learning new tools and habits for better sexual functioning, through specific exercises assigned to do at home on your own or with your partner) and a psychodynamic approach (the exploration of the childhood messages, the experiences of sexual development and your core beliefs about yourself).

    If you are in a relationship, couples therapy may be appropriate, because sexual problems impact on a relationship and vice-versa.

    The most common psychosexual problems are:
    For men: erectile dysfunction, premature ejaculation, retarded ejaculation.
    For women: vaginismus (women who cannot have penetrative sex), dyspareunia and vulvodynia (painful intercourse).
    For both: Difficulties with orgasms, loss of libido, differences in sexual desire within the relationship, sexless relationships, lack of intimacy.

    Psychosexual therapy is the best therapy to treat sexual problems of psychological causes. Over the decades, psychosexual therapy has proved to be successful in obtaining long-lasting positive outcomes.

    Making the first appointment for psychosexual therapy is very scary because it involves such an intimate subject, which touches the very core of our being. However, it is a necessary step towards satisfying and fulfilling sex lives and, ultimately, happier intimate relationships.

    Published by Silva Neves on 14th April 2014.









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